Expert urges better care of elderly

A British expert on care for the elderly says more geriatric medical specialists are needed in this country.

Geriatric medical specialists provide diagnosis and care of complex conditions like dementia in the elderly.

“If the health minister was here, I would be having this conversation. This isn’t a quick fix. You are not going to be able to turn this around in six months or a year. It is probably a 10-year program to gradually, incrementally, increase geriatric medicine,” said Prof. John Young, head of the academic unit of elderly care and rehabilitation at Leeds University’s school of medicine.

Young, a physician, is also working with Britain’s National Health Service’s commissioning board to improve delivery of services to older people. He was a keynote speaker Friday at the 42nd annual scientific meeting of the Canadian Association on Gerontology in Halifax.

“With this style of practice, geriatric medicine, you get better outcomes for these people, so why do you not want to get better outcomes,” he said Friday during a visit to The Chronicle Herald’s editorial board. Young was accompanied by Dr. Kenneth Rockwood, a physician at the Queen Elizabeth II Health Sciences Centre and professor of geriatric medicine and neurology at Dalhousie University.

Britain has revamped its system of care for elderly people and now has large teams of geriatric medical specialists working in hospitals, and increasingly in the community.

Young estimates that the United Kingdom has about 3,000 geriatric specialists for a population of roughly 60 million. It is now the largest medical specialty in Britain, he said.

“Once (people) get into it they realize that it is hugely rewarding because you are not dealing with little snippets of people, you are dealing with the whole person,” he said.

Canada, on the other hand, has far fewer — about 300 geriatric medicine specialists for its roughly 35 million people, Rockwood said.

“We are probably only a third of where we need to be on that.”

Nova Scotia, which has the oldest and fastest aging population in the country, currently has 11 geriatric specialists, he said.

Geriatric medical specialists first complete an internal medicine specialty, and then complete additional training program in geriatrics.

This province has “a cap of two (students)” at a time for its geriatric medicine program, Rockwood said. “We are going to turn (applicants) away.”

As well, family doctors in this province don’t receive any financial incentive to provide care to patients with dementia, which can be time-consuming, he said.

Rockwood says the province must reshape the way it provides health care to the elderly, based on up-to-date scientific research and by putting the needs of patients first.

“We haven’t organized (care) in the right way and the dementia strategy should look at that,” he said.

A number of patients with dementia in Nova Scotia undergo intensive medical procedures, such as chemotherapy or bypass surgery, causing further deterioration of their condition, he said.

“We are spending a lot of money to get a bad outcome.”

While additional long-term care is needed for people with dementia in Nova Scotia, more long-term care beds may not be the answer, Rockwood said.

“We need to look at why we have built so many beds and we haven’t dented the wait list. What are we doing that is (encouraging) people to go to long-term care, because most people don’t put it down as their first preference. (I don’t want) to demonize long-term care. It is ideal for some people, but we need to take a hard look at that,” Rockwood said.